Tang Hao-Chen, Xiang Ming, Chen Hang, Hu Xiao-Chuan, Yang Shun, Yang Guo-Yong
Zhongguo Gu Shang. 2014 Feb;27(2):161-4.
To investigate the clinical outcomes of cannulated screw combined with buttress plate in treating transarticular shear fractures of the distal humerus.
From July 2008 to December 2011, 17 patients with shear fractures of the distal humerus were treated with cannulated screw combined with buttress plate. Among them, included 10 males and 7 females aged from 20 to 59 years old (mean 36.5). All the fractures were classified into type I (8 cases), type II (1 case), type III (3 cases) and type IV (5 cases) according to Bryan-Morrey and McKee classification. According to AO/ASIF classification, 10 cases were type 13B3.1, 7 cases were type 13B3.3; according to Dubberley classification, 5 cases with type 1A, 2 cases with type 1B, 2 cases with type 2A, 2 cases with type 2B, 4 cases with type 3A, 2 cases with type 3B. There were 12 cases with fresh injuries, 4 cases with old injuries. All fractures were closed injuries. Complications and range of motion of elbow were observed, and clinical efficacy were evaluated by Broberg-Morrey standard.
All patients were followed up with a mean time of 21.3 months (ranged, 18 to 24). All fractures obtained bone healing from 10 to 15 weeks with a mean of 12.5 weeks. No malunion or delayed healing occurred. Two cases occurred ossification in lateral collateral ligament attachment. 2 cases occurred heterotopic ossification in the capitellum in front of capsule joint. The range of elbow extension was (16 +/- 7) degrees, flexion was (115 +/- 9) degrees, the average are of pronation and supination was (65 +/- 5) degrees and (60 +/- 5) degrees respectively. According to Broberg-Morrey standard, there were excellent in 7 cases, good in 8 cases, fair in 2 cases, and average score was 92.44 +/- 4.64.
For transarticular shear fractures of the distal humerus, classification should be performed according to preoperative X-ray and CT, cannulated screw and buttress plate combined and early function rehabilitation could recover elbow function.
探讨空心钉联合支撑钢板治疗肱骨远端经关节面剪切骨折的临床疗效。
2008年7月至2011年12月，采用空心钉联合支撑钢板治疗17例肱骨远端剪切骨折患者。其中男10例，女7例，年龄20～59岁，平均36.5岁。所有骨折按Bryan-Morrey和McKee分类法分为Ⅰ型8例、Ⅱ型1例、Ⅲ型3例、Ⅳ型5例。按AO/ASIF分类法，13B3.1型10例，13B3.3型7例；按Dubberley分类法，1A型5例，1B型2例，2A型2例，2B型2例，3A型4例，3B型2例。新鲜损伤12例，陈旧损伤4例。均为闭合性损伤。观察并发症及肘关节活动范围，采用Broberg-Morrey标准评价临床疗效。
所有患者均获随访，平均随访时间21.3个月（18～24个月）。所有骨折均于10～15周获得骨性愈合，平均愈合时间12.5周。无畸形愈合或延迟愈合发生。2例出现外侧副韧带附着处骨化。2例在关节囊前方的肱骨小头处出现异位骨化。肘关节伸直范围为（16±7）°，屈曲范围为（115±9）°，旋前平均范围为（65±5）°，旋后平均范围为（60±5）°。按Broberg-Morrey标准，优7例，良8例，可2例，平均评分为92.44±4.64。
对于肱骨远端经关节面剪切骨折，应根据术前X线及CT进行分型，采用空心钉联合支撑钢板内固定并早期进行功能康复，可恢复肘关节功能。
